This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on ISI (5)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: In their Research Letter, Mr Baggott and colleagues¹ report that they performed a chemical analysis of 3,4-methylenedioxymethamphetamine (MDMA) tablets, also known as "ecstasy," and found that such tablets frequently contain dextromethorphan. The authors imply that findings of "lethargy or hyperexcitability, tachycardia, ataxia, and nystagmus, as well as a phencyclidine-like psychosis" can occur only in dextromethorphan toxicity. Furthermore, they suggest that these findings in patients admitting ecstasy use, but in whom the results of toxicology screens are negative for MDMA and amphetamines, should lead clinicians to consider dextromethorphan toxicity. Both of these statements are misleading.

Each of the above symptoms may arise from MDMA use. Effects of MDMA include tachycardia, hypertension, hyperthermia, hepatitis, myocardial ischemia, elevated antidiuretic hormone levels, serotonin syndrome, cerebral hemorrhage, and psychosis.² In those who use pure MDMA, lethargy may represent a postictal state caused by hyponatremia, hyperthermia, or cerebral hemorrhage. Tachycardia, hyperexcitability, tremor, ataxia, . . . [Full Text of this Article]